Revealed: Britain’s top surgeons for breast cancer

reconstruction surgery – as voted by the specialists

themselves

Last month, breast cancer survivor Yvonne Laidlaw, 57, was awarded £37,000 compensation for reconstruction that left her feeling like a freak, with one breast higher and smaller than the other.

She said her joy at overcoming cancer was replaced for loathing of her body following this ‘cosmetic disaster’. She warned other women to see a consultant specialising in reconstructive techniques.

Clearing the cancer is naturally the priority. But when it comes to reconstruction, there are a host of other issues: do you go for breast reconstruction at the time of the cancer surgery – as Mrs Laidlaw did – or delayed reconstruction?

These decisions might be dictated by personal choice – some patients feel they want to put the cancer behind them and don’t want to be rushed into a decision about the type of breast reconstruction they want so soon after being diagnosed.

For others also undergoing radiotherapy, doctors might recommend postponing reconstruction, as treatment can harden tissues and damage the reconstruction.

More seriously, if the patient develops an infection or other complication following reconstruction, this could delay the start of chemotherapy. This is because chemotherapy works by hitting the fastest-growing cells, which, as well as cancer cells, include white blood cells that fight infection.

Finding the right surgeon might help resolve these issues. But working out your options can be difficult when removing the cancer and rebuilding the breasts can be carried out by three types of surgeons.

‘Breast surgeons are general surgeons whose job is tackling the cancer with a lumpectomy or mastectomy,’ says Adam Searle, consultant plastic and reconstructive surgeon at the Royal Marsden Hospital, London.

‘Some have done further training in plastic surgery and are called oncoplastic surgeons – they clear the cancer and will do some reconstruction.’

Finally, there are plastic and reconstructive surgeons who offer the full range of reconstruction techniques, including the most challenging microsurgery where fat is taken from one part of the body to rebuild the breast.

‘When women want an immediate reconstruction, a plastic and reconstructive surgeon works in a team with a breast surgeon who removes the cancer, and then the plastic surgeon takes over,’ says Mr Searle.

So how do you navigate this course and do all you can to avoid Mrs Laidlaw’s experience?

That’s what the Daily Mail set out to do. Our object was to search out the top-rated surgeons across the spectrum in breast cancer surgery up and down the country.

We felt those best placed to rate the top practitioners would be other breast cancer and reconstructive surgeons. So we canvassed 50 leading surgeons and asked them: ‘If your nearest and dearest were to be diagnosed with breast cancer, to whom would you refer them?’

While the top ten surgeons are not evenly distributed around the country, this shouldn’t necessarily be an obstacle for patients.

Under NICE guidelines, all patients should be offered all reconstruction options, even if these aren’t available locally.

Patients are entitled to be referred farther afield on the NHS. Of course, this is only a guide and not a scientific study – there are countless highly skilled surgeons all over the country who didn’t make it into the top ten, yet who spend every day of their working lives rebuilding not just breasts, but shattered self-esteem, too.

OUR TOP 10

Here are Britain’s top ten reconstructive surgeons as voted for by their peers, in no particular order. All work in the NHS and privately.

WHAT THEY SAY ABOUT HIM: Respected and skilful surgeon who can combine cancer clearance with immediate breast reconstruction. Very firm beliefs on what is best for patients, but knows his own limitations. He will refer a patient to a plastic surgeon if he feels they will benefit from surgery such as DIEP-flaps, where spare fat is taken from the tummy to recreate the breast.

WHAT THEY SAY ABOUT HIM: He is technically excellent and has pushed the boundaries with the most challenging microsurgical techniques. Free flaps – pieces of tissue from, say, the tummy – are taken to recreate the breast. Microsurgons have to be able to plumb veins with the tiniest stitches to ensure that transplanted tissue survives in its new home in the breast.

WHAT THEY SAY ABOUT HER: A great innovator, who has helped pioneer the latest techniques and takes an artistic view of the breast and what can be done to create the best cosmetic result. Also has the psychological skills to support her patients and help them through a difficult time.

Consultant plastic and reconstructive surgeon, Royal Free Hospital, London

WHAT THEY SAY ABOUT HIM: Fine pair of hands and a good decision-maker.

DOUGLAS MACMILLAN

Oncoplastic surgeon, Nottingham Breast Unit, Nottingham City Hospital

WHAT THEY SAY ABOUT HIM: Often works as a team with Stephen McCulley. Regarded as good at determining what surgical approach to take in order to get the best results. Forward thinking.

RICHARD SUTTON

Oncoplastic surgeon, Royal United Hospital, Bath

WHAT THEY SAY ABOUT HIM: Highly skilled at skin and nipple-sparing mastectomy. Knows what he can do and does it well. Skin-sparing mastectomy is usually done with an incision around the areola, with the breast tissue then being shelled out through this hole. But it can also be done with an incision in the breast crease. It isn’t always possible to spare the nipple when the cancer is close by because it can be hard to ensure you’ve moved all traces of the disease. These women will go on to have nipple reconstruction and tattooing.

RICHARD HAYWOOD

Consultant plastic and reconstructive surgeon, Norfolk and Norwich University Hospital

WHAT THEY SAY ABOUT HIM: Regarded as a very good microsurgeon.

ST JOHN COLLIER

Breast surgeon, Basildon University hospital

WHAT THEY SAY ABOUT HIM: ‘Phenomenal and meticulous’ breast surgeon. Takes out all tissue without damaging the skin.